The dorsal carpometacarpal ligaments are short fibrous bands on the dorsal surface of the hand connecting the distal carpal row to the dorsal bases of the index through small finger metacarpals. Multiple obliquely oriented slips reinforce the dorsal CMC joint capsules and resist palmar subluxation of the metacarpal bases.
Maintain dorsal CMC joint stability and resist flexion forces at the metacarpal bases, complementing the palmar ligaments and providing the primary resistance to distraction and dorsal angulation.
Dorsal CMC ligament tears accompany both fracture-dislocations and pure dislocations, which can be subtle on plain radiographs. Oblique and CT views are often required to demonstrate displacement. The dorsal approach to CMC fractures requires identification and protection of the extensor tendons and dorsal sensory nerves before ligament repair. Missed injuries produce chronic dorsal instability and painful arthrosis.
Disruption of dorsal and palmar CMC ligaments allows complete metacarpal base dislocation, typically dorsal, producing visible metacarpal shortening and a palpable dorsal prominence, requiring urgent reduction.
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